Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease

Po-Chen Lin,Feng-Chi Chang,Jui-Yao Tsai,Hui-Chi Huang,Chih-Ping Chung,Yung-Yang Lin

doi:10.1186/s12883-017-0918-y

Abstract

BackgroundBasilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS). It is currently unknown whether white matter hyperintensity(WMH), a marker of small vessel disease(SVD), is associated with BABAD.MethodsThe present study analyzed data from patients with PCS who were enrolled in the Taipei Veterans General Hospital Stroke Registry between January 1, 2010 and February 28, 2014. WMH severity was rated using the Scheltens scale. We used multivariate analyses to: (1) compare the severity of WMH between patients with BABAD, patients with large-artery > 50% atherosclerotic stenosis-related PCS(LAA), and non-stroke subjects(NS); and (2) evaluate the relationship between WMH severity and the 3-month prognosis of patients with BABAD.ResultsThe study pool included 151 BABAD, 97 LAA, and 78 non-stroke patients. Multivariate analyses adjusting for age, sex, and vascular risk factors showed that compared to patients with LAA [Odds ratio(OR) = 0.51, p = 0.037] and NS (OR = 0.40, p = 0.004), patients with BABAD (OR = 1) had greater WMH severity (score ≥ 50th percentile) in periventricular, but not subcortical, regions. Moreover, greater periventricular WMH severity predicted poor 3-month functional outcomes (modified Rankin Scale > 3) with an OR of 3.21 (p = 0.028) in BABAD patients.ConclusionsWe are the first to show a significant association between WMH and BABAD that is independent of vascular risk factors and atherosclerotic large-artery disease. Our results suggest that small vessel abnormalities other than lipohyalinosis may be involved in BABAD pathophysiology. A future management strategy should include both large and small vessel protection.

Highlights

Basilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS)
The pons was the most common location involved in BABAD and large artery atherosclerotic stenosis (LAA) (93.4% versus 50.5%)
In the BABAD group, severe vertebrobasilar artery (VBA) stenosis (> 50%) was not present; severe internal carotid artery (ICA) and middle cerebral artery (MCA) stenosis were present in 43.0% and 24.5% of the subjects, respectively

Summary

Introduction

Basilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS). It is currently unknown whether white matter hyperintensity(WMH), a marker of small vessel disease(SVD), is associated with BABAD. We hypothesized that in addition to large-artery atherosclerosis, BAD pathophysiology may involve small vessel abnormalities, which would be reflected by (1) greater WMH severity in the BABAD group compared to the NS and LAA groups or (2) an association between WMH severity and the 3-month functional outcome of the BABAD group

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